Surgeon admits to branding initials on patients' livers
cnn.com
cnn.com
- Breach of patient-doctor trust -- a very asymmetric relationship
- Breach of the Hippocratic Oath (you don't *burn* healthy tissue without good reason)
- Permanent bodily modification without consent
- *Multiple* offenses
It's a tough call, for sure, but to exonerate him or, worse, downplay these egregious violations as "victimless crimes" is, to me, unfathomable.
> people grade things into "acceptable" levels of bad behaviour.
So I don't see anyone grading anything into acceptable levels of (bad) behaviour. Putting behaviour in proportion to find adequate punishment is part of the judiciary system which you can find back as working decently since trias politica invention.
It's unethical for sure, but I guess my gut reaction is that it's not necessarily an offense that demands termination.
Someone murdered someone near my workplace. This surgeon branding his initials on someone's liver isn't so bad in comparison. Therefore, it isn't so bad in the absolute.
You set up the slope yourself and then proceeded to slip on it.
I'm not trying to defend him, but it wasn't intended to be a permanent marking.
He only initialed livers as part of a wider set of markings that surgeons normally make. If the initials are going to be a problem those other normal marks would also be a problem.
I mean.. at least you know who to sue.
He pled guilty to a criminal offence, but that offence is at the lower range. (Assault covers a range, from assault at the low end (doesn't require physical contact), then assault by battery (requires physical contact) to ABH then GBH.
I think he's going to get a suspended sentence.
He's got a warning from an interim hearing from MPTS, and you can see the warning on the GMC lists.
Does this work?
http://webcache.gmc-uk.org/gmclrmp_enu/start.swe?SWECmd=Goto...
Here's the text of the warning:
> In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning.
Also, it would help if you did not include the word 'fantast' in a novelty account while making claims of being a physician for 16 years and then making light of this. Either you really are a fantast or you are not exactly a credit to your profession if you really believe that this does not warrant termination. As a patient I'm pretty cool with it, if I go under to trust a doctor with my life I'd rather not they use me as a calligraphy scratchpad and if it takes one doctor out of all those out there to be made an example of then it's a loss but not a large enough loss to offset the breach of trust between doctors and patients the world over by this guy.
If it is a question of 'not having enough doctors' so we need to keep bad physicians around, then that's another reason that we need to drastically increase our enrollments for medical school. We certainly have enough willing and able Americans that would be ecstatic for the opportunity.
I assume physicians have something like law-enforcement's 'blue line', but it's pretty imperative that professionals like you hold each other accountable.
//edit// I'm not sure why this evokes such a strong reaction in me. I think it's because it's like a claim of "ownership".
That's because of the use of the word "branding", which is what cattle farmers do to their animals to indicate ownership. Had they used something more value-neutral like "initialed", our reactions wouldn't be nearly as strong.
(I'm not saying that "branding" is the wrong word to use, nor that "initialed" would have been better, just that the specific words we hear matter, even when their meaning is mostly the same)
But it's really dumb, and should lead to disciplinary consequences (although his reputation is already badly damaged) because of the paranoia it triggers in people about doctors.
What I wonder is why the surgeons who discovered it got the problem out in the public. What was possibly their goal ?
You must be Dr. Manhattan. It's a big deal to us uneducated ants but you're enlightened so you can see it for what it is, is that right?
Actually, you are simply too arrogant to see it.
Easy question : do you know what it looks like ? I think no picture has been published, I infer what it probably looks like out of what I've seen and my experience which is relevant in this case, but most people are probably not able to do so (this is arrogant I guess ?).
BUT it is indeed bad and damaging for the doctor/patient relationship, which is today even more prevalent than the care one.
I have not seen a photo of it, but it's frankly irrelevant. You're shoehorning in your experience of having seen exposed organs as giving you some kind of expertise; but it does not, this is an issue of ethics about a breach of body autonomy and consent.
>BUT it is indeed bad and damaging for the doctor/patient relationship, which is today even more prevalent than the care one.
This is a very mechanistic interpretation which does not regard justice or principles as being a thing and only considers results.
He was prosecuted and convicted for a minor offence ("assault by battery" is almost the lowest level of this offence) and because he pled guilty the more serious charge ("assault causing actual bodily harm" (ABH)) was dropped.
Some doctors in UK have been convicted of manslaughter by gross negligence (a far more serious criminal charge) and were able to return to practice after a time of suspension, so he might be able to return to work.
He's been through a hearing at MPTS (the independent medical tribunal service) after a complaint to the GMC (the regulatory body for doctors in UK). I think it was an interim hearing, and they're waiting for the criminal trial to finish.
But here's the warning he got:
> In August 2013 and on more than one other occasion Mr Bramhall initialled patients’ livers using an argon beam coagulator. This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated. The required standards are set out in Good Medical Practice and associated guidance. In this case, paragraph 47 and 65 of Good Medical Practice are particularly relevant. 47. You must treat patients as individuals and respect their dignity and privacy. 65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. Whilst this failing in itself is not so serious as to require any restriction on Mr Bramhall's registration, it is necessary in response to issue this formal warning.
They had several options: they could have prevented him from working; they could have required him to take action to prevent re-occurance.
Please, please, really consider what it means to ruin someone's life when advocating for a certain punishment. There's a whole range of reactions between "eh, no big deal" and "destroy his career!"
Whatever the man did, what he didn't do was kill anyone or permanently curtail someone's professional life or put someone in a cell for days/months/years.
All of the punishments discussed also remove a functioning surgeon from being a contributing member of society.
I'm just saying, it's worth thinking about.
I feel like we all get so self-righteous and don't think about how much impact these punishments have. It's like, a friend of mine always argued we should really bring back public spanking. Sounds like a joke, but her point was there should be a type of punishment that is the equivalent of society yelling a whole bunch at you very very sternly and making you feel very very embarrassed and then you moving on with your life and continuing to contribute to society.
I don't have much of a problem with very severe punishments for things that (1) the person knew they weren't supposed to do; and (2) can't be done by accident.
> her point was there should be a type of punishment that is the equivalent of society yelling a whole bunch at you very very sternly and making you feel very very embarrassed and then you moving on with your life and continuing to contribute to society
This sounds more like the stocks than a public spanking (spanking?).
A public shaming works better when everyone agrees on what's shameful. As soon as you have groups who honor getting thrown in the stocks, a lot of the point of throwing people in the stocks disappears.
Keep in mind that you're on an operating table, passed out and 100% dependent on those working on you. To treat you like a graffiti wall is not only disrespectful, it wastes time under narcosis which carries some minimal risk, and potentially could lead to complications (though not related, complications were the reason this was discovered in the first place).
Let's say that treating this guy like a trendsetter would definitely not have my vote. I've been operated on a couple of times in my life and I'm pretty sure that the surgeons that did that would be far more angry about this than a patient ever would be because this guy damaged all of the medical profession for his personal gratification.
On the act itself, I am in the number of those who think this should be taken extremely seriously and it is good ground for losing the license and criminal charges. Scarring someone's body (against their own will) has been for long (and until a few decades ago) a sign of property and slavery, and although I do not think this was what this surgeon intended, it still must be considered an extreme humiliation. Also, a surgeon's professional position usually entails an important amount of responsibilities and power, so violation of the public's trust in them are very important matter.
> “He’s a big fan of yours, too, pal, ever since the bone flap thing.” The bone flap incident had occurred early in Gary’s chief year. Fred and Gary were performing a cranial operation to remove a benign brain tumor. Fred had performed the entire operation himself—a grave insult to a chief resident, known as “stealing the case.” After Fred left the OR, further irritating the chief by dumping upon him the tedium of closing the wound, an angry Gary had engraved the phrase “Fred sucks” with the electrocautery knife on the inside of the bone flap, the plate of skull bone that is temporarily sawed away to gain access to the brain. He had then wired the flap back into place, thinking that the inside of the patient’s skull would never again see the light of day. Unfortunately, the bone flap developed a staph infection and had to be removed a week later. Once contaminated with bacteria, the free piece of skull must be removed to cure the infection. The soft spot is filled in with plastic several months later. Gary coerced me into assisting Fred with the surgical removal of the infected flap. I’ll never forget the almost unintelligible stream of invectives that spewed forth when Fred saw Gary’s skull graffitti. Fred was too embarrassed to send the discarded flap to the pathology department as it was, and we spent an hour drilling the message off the bone before allowing it to leave the OR.
Considering the type of personality that surgery attracts, I see why this happens. That said, I don't think this is a common occurrence. (And it should go without saying, but such actions are unethical, unprofessional, and worthy of criminal charges.)
He was proud of his handiwork and signed off on it. Have we enough skilled surgeons to remove them for a harmless boast? Reprimanded, sure, but removing him from his post is both an over reaction and unfair to society which is already lacking in skilled healthcare professionals.
If his ego/vanity changes the actions that he takes when performing surgery, that sounds like a problem to me.
If we're sticking to car analogies he wrote his name in the dirt on the back of a truck, but the dirt was abrasive and so he also scratched his initials into the paint.
That is, a patient who gets signed upon and one who doesn't following the exact same procedure for the rest are at an identical risk?
> Oxford student given suspended sentence for stabbing boyfriend
> Judge had reportedly earlier told Lavinia Woodward a prison term could damage her prospects of becoming a heart surgeon
[1] https://www.theguardian.com/law/2017/sep/25/oxford-student-l...
It is part of a bad culture among medical doctors, where they both torture themselves and apparently others as well. The profession as a whole should really wake up or they will face a similar reaction as taxi drivers did with the introduction of Uber and Lyft. Nobody want’s to be forced to be a customer in businesses that supersede customer trust for ego.
Is it certain that a couple inches of laser beam scar tissue in a liver has not, and will not in the future cause any medical issues for the patients in question?
Even minor scarring adds to the bodies burden in healing, so I think it's hard to definitively say that the laser inscribed initials did not cause any harm or increased risk at all. After all, these were not strong, healthy people -- they were sick enough to require liver surgery... and one of them had to have followup treatment which is when the initials were discovered.
It could well lead to Cirrhosis of the liver. Not to mention Adhesion that could become painful. I'm not too sure how likely either issue is, however I wouldn't like to assume that scarring your liver is going to be completely free of complications... Though by the time you're having an intraoperative procedure done on your liver, you're already not free from complications.
Do you have any medical background ? Did you ever use a coagulator ? Or ever saw a liver with your own eyes and the eventual scars those get because of routinely occurring small infarctii or such ? I doubt so, as this is utter bullshit.
> I'm not too sure how likely either issue is
Not likely at all in this universe
Briefly, working as a theatre technician in coronary intervention. We used diathermy etc in the lab.
In this case he did it to a patient and the marks didn't heal. (By definition he works on patients who's livers are less likely to heal), but it didn't cause any further harm.
I understand a professional wanting to "sign off" on their work; programmers, scientists, artists, engineers and so forth really like putting their name on things so why not doctors?
If he were forthcoming maybe only 10% of patients might agree to it, but that should probably be enough to scratch some egotistic itch.
The article says the following
> Bramhall's handiwork didn't appear to damage either liver
These are not even close to the same thing.
It's possible he takes less pride too. For example, he might notice that out of 50 patients, only you consented to him signing on your organs for his ego. So it is possible that from his point of view, you don't care that much (compared to the other patients). So maybe try other things on your organs that he has been thinking about, maybe play around a little in other ways, test the boundaries a bit. Throw a few harmless things in there just for fun. Why not? You'd probably consent anyways.
Why risk trying those things on other patients when he can try it on you, the person who consented?
One is signing on a piece of object, and one is signing on a live human being. An object and a human being are hugely different things.
That would be like saying, well I can write my name on my own piece of paper, why can't I tattoo my name on your back? No one can see it.
Also, one is a "creation", and one is just "fixing". An engineer signing a circuit board that she created, is very different from a doctor signing on a person that she did not create.